| NPI | 1912055625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: MI 4301081186) |
| Additional Taxonomies | 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: MI 4301081186) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |